Five-Second Squeeze Testing in 333 Professional and Semiprofessional Male Ice Hockey Players: How Are Hip and Groin Symptoms, Strength, and Sporting Function Related?

High Prevalence of Seasonal and Current Groin Problems in Rink Hockey Players

Groin problems are common in multidirectional sports. The aim of the present study is to assess seasonal, current, and trends for groin problems in rink hockey players, irrespective of their playing position, age, or gender. Rink hockey players from three countries [n=446 (162 female, 284 male)] were invited to participate in an online questionnaire. This form evaluated the prevalence of groin problems (time-loss and non-time-loss) for the 2022-2023 season, as well as monthly prevalence of groin problems (time-loss and non-time-loss). All groin problems were compared between playing position, gender, and age to assess between-group differences. Senior males reported the highest time-loss (25%) and non-time-loss (51%) for seasonal prevalence; while U-17 males reported the lowest in both categories of groin problems (time-loss 9%, non-time-loss 27%). No significant differences between playing position or gender were found for any of the groin problems analyzed. In-season prevalence (9-15.7%) of groin problems was significantly higher than pre-season (7.4%) prevalence (p<0.01). Seasonal prevalence of groin problems is common in rink hockey, regardless of gender, playing position, or age. Preventive efforts should be directed towards all players, regardless of their individual characteristics.

Associations Between Hip Pathology, Hip and Groin Pain, and Injuries in Hockey Athletes: A Clinical Commentary

Femoroacetabular impingement (FAI), particularly cam morphology, is highly prevalent among elite hockey athletes. Moreover, hip and groin pain has become a common issue in hockey, with approximately 50% of European professional athletes reported to experience a hip or groin problem during a season. While most athletes will not miss training or competition due to this, restricted competitive performance and increased risk of reduced physical and psychological well-being are likely. Recent research suggests that the development of cam morphology is related to the repetitive shear stresses experienced at the hip joint during adolescence from skating. This condition likely increases the potential for intra-articular and extra-articular injuries in these athletes later in their careers. Research also indicates that the hip joint mechanics during forward skating substantially increase the possibility of sustaining a labral tear compared to other sports. Such an injury can increase femoral head movement within the joint, potentially causing secondary damage to the iliofemoral ligament, ligamentum teres and joint capsule. These injuries and the high density of nociceptors in the affected structures may explain the high prevalence of hip and groin pain in hockey athletes. Compensatory adaptations, such as reduced hip strength, stability, and range-of-motion (ROM) likely increase the opportunity for core muscle injuries and hip flexor and adductor injuries. Specifically, the limited hip ROM associated with cam morphology appears to exacerbate the risk of these injuries as there will be an increase in pubic symphysis stress and transverse strain during rotational movements. It is hoped that this article will assist practitioners currently working with hockey athletes to develop evidence-informed monitoring strategies and training interventions, aimed at reducing the incidence and severity of hip and groin problems, ultimately enhancing athlete performance and well-being. Therefore, the purpose of this clinical commentary was to examine current evidence on common hip pathologies in hockey athletes, exploring potential associations between hip and groin pain and the biomechanics of hockey activities.

Level of Evidence

5.

Inter- and intra-session variability of compression strain gauge for the adductor groin squeeze test on soccer athletes

The importance of hip adductor strength for injury prevention and performance benefits is well documented. The purpose of this study was to establish the intra- and inter-day variability of peak force (PF) of a groin squeeze protocol using a custom-designed compression strain gauge device. Sixteen semi-professional soccer players completed three trials over three separate testing occasions with at least 24-h rest between each session. The main findings were that the compression strain gauge was a reliable device for measuring PF within and between days. All intraclass correlations were higher than 0.80 and coefficients of variations were below 10% across the different sessions and trials. Due to the information gained through the compression strain gauge, the higher sampling frequency utilized, portability, and the relatively affordable price, this device offers an effective alternative for measuring maximal strength for hip adduction.

The science and art of testing in ice hockey: a systematic review of twenty years of research

Introduction

Ice hockey is a complex sport requiring multiple athletic and technical attributes. Considering the variety of tests developed, on-ice testing protocols have been created to measure the physiological and mechanical attributes associated with performance. To our knowledge, a lack of technical resources exists to help stakeholders opt for on-ice protocols from among those developed. It becomes crucial for researchers and practitioners to select relevant and context-specific procedures. This systematic review of the literature outlines an inventory of the on-ice tests that have been used in the domain of ice hockey research over the last twenty years, and summarize protocols mostly used in major athletic components.

Methods

A search was performed on three databases (PubMed, SPORTDiscus and Scopus) by following the PRISMA guidelines. Specific keywords were selected to find publications using on-ice testing protocols in the methodology. Four aspects of athletic attributes were used to categorize the protocols: aerobic capacity, acceleration-speed, agility-change of direction and ability to repeat skating sprints. Analyses were conducted regarding four categories of observations: population under study, on-ice reported test(s), outcomes measures and main findings.

Results

A total of 107 articles were included, resulting in 55 on-ice tests related to the on-ice assessments of four major athletic components: aerobic capacity (n = 7), acceleration-speed (n = 6), agility and change of direction (n = 23) and repeated skating sprint ability (n = 19). Testing in male and older cohorts (≥16 years old) predominates, with a primary focus on the competitive amateur level. The selected tests were mainly designed for assessing on-ice physiological responses and fitness (n = 38), talent identification-team selection (n = 19), efficiency of interventions (n = 17) and validation purposes (n = 16).

Conclusion

A prevalence of on-ice skating tests to assess the ability to repeat intense efforts, agility, acceleration and speed components exists, which are relevant and linked to match requirement. The wealth of on-ice tests used in the literature reflects the need to adapt the on-ice evaluation process to the population, constraints, and goals. This review is a valid toolbox and can benefit for researchers and practitioners interested in testing hockey players from different levels, with a variety of aims and needs, by helping them to select the relevant procedures to their environment and practice context.

Maximal and Explosive Muscle Strength During Hip Adduction Squeeze and Hip Abduction Press Test Using A Handheld Dynamometer: An Intra- and Inter-tester Reliability Study

Background

Hip adduction and abduction muscle function plays an important role for risk of groin pain in athletes. Maximal isometric strength can be obtained clinically using a handheld dynamometer. However, in very strong athletes this is challenging, as external fixation of the dynamometer is needed for reliable measures. An alternative to unilateral testing, is the long-lever hip adduction squeeze test and a novel bilateral hip abduction press test. While promising intra-tester reliability has been found for maximal strength during the long-lever hip adduction squeeze test, inter-tester reliability may be more challenging during both maximal and explosive strength measurements.

Hypothesis/purpose

The aim of the present study was to assess intra- and inter-tester reliability of maximal, and explosive strength during the long lever hip adduction squeeze test and the long lever hip abduction press test in healthy adults using a hand-held dynamometer.

Study design

Intra- and interrater reliability study.

Methods

Forty-nine healthy subjects were included for intra- (n=20) and inter-tester reliability (n=29). Subjects performed the hip adduction long lever squeeze test and the bilateral hip abduction press test in a randomized order. Maximal isometric strength and early (0-100 ms) and late (0-200 ms) phase rate of force development (explosive muscle strength) was obtained using a hand-held dynamometer. Relative reliability for all tests was assessed using ICC2,1 two-way mixed model with absolute agreement, thereby taking bias between testers into account.

Results

Maximal isometric strength showed good intra- and inter-tester reliability for adduction (ICC: 0.93-0.97) and abduction (ICC: 0.88-0.92). For 0-200 ms rate of force development, both the squeeze and press test showed good intra-tester reliability (ICC: 0.85-0.87), whereas inter-tester reliability was good for hip adduction squeeze (ICC: 0.75) and moderate for hip abduction press (ICC: 0.71). For 0-100 ms rate of force development, the hip abduction press test showed good intra-tester reliability (ICC: 0.78). Remaining tests for intra- and inter-tester reliability showed moderate reliability (ICC: 0.50-0.71).

Conclusion

Assessment of maximal isometric strength in hip adduction squeeze and abduction press test showed good intra- and inter-tester reliability, whereas only 0-200 ms rate of force development demonstrated good intra-tester reliability of both tests. Therefore, rate of force development should preferably be conducted by the same tester, while the long lever squeeze and press test can reliably be used within- and between testers to measure maximal isometric strength.

Level of Evidence

3©The Author(s).

Functional Movement Patterns, Spinal Posture and Prevalence of Musculoskeletal Symptoms among Elite Ice Hockey Players: A Cross Sectional Study

The aim of this study was to evaluate functional movement patterns and spinal posture of elite ice hockey players and to examine the association between spinal posture, prevalence of musculoskeletal symptoms and Functional Movement Screen (FMSTM) scores. The study included 86 elite male ice hockey players aged 18 to 38 years. Sagittal spinal curvatures were measured with a Saunders digital inclinometer, and functional movement patterns were assessed by the FMSTM. Spinal posture of the studied ice hockey players was characterized by normal kyphosis (46%) or hyperkyphosis (41%) and decreased lumbar lordosis (54%). The mean total FMSTM score was 14.8. Most of the hockey players (57%) achieved a total FMSTM score in the range of 14-17 points, whereas 28% had a total FMSTM score of <14. Seventy-two percent of the studied athletes had at least one asymmetry. Significant differences between performing the movements on the right and the left sides of the body were observed in in-line lunges (p = 0.019) and shoulder mobility sub-tests (p < 0.001). The FMSTM sub-tests performed with the lowest success rates were rotatory stability and the hurdle step. A lower score in the rotatory stability test is related to shoulder pain. It is highly important to develop appropriate exercise programs to reduce or prevent muscle imbalances in ice hockey players.

Midseason Screening for Groin Pain, Severity, and Disability in 101 Elite American Youth Soccer Players: A Cross-Sectional Study

OBJECTIVE

To (1) systematically screen for groin pain and type in young elite soccer players and (2) assess whether hip and groin-related severity and disability differed between players with different levels of groin pain and tenderness.

DESIGN

Cross-sectional observational.

SETTING

Elite American soccer academy at midseason.

PARTICIPANTS

One hundred one academy soccer players (mean age 14.3 ± 1.8 years).

INTERVENTION

All players underwent clinical examinations to classify groin pain by the Doha agreement taxonomy.

MAIN OUTCOME MEASURES

Tests for groin-related severity and disability included the Copenhagen 5-second squeeze test, Copenhagen Hip and Groin Outcome Score (HAGOS), and Hip Outcome Score (HOS). Players were stratified into 3 groups: those with groin pain, those with tenderness, and those with no groin pain or tenderness.

RESULTS

Twenty-two players (22%) reported groin pain. Adductor-related groin pain was the most common (n = 14), followed by iliopsoas-related (n = 3), and pubic-related (n = 2). Multiple locations were present in 3 players. Thirty-nine players (39%) did not have groin pain but were tender to palpation in 1 or more structures related to the Doha agreement taxonomy. Copenhagen 5-second squeeze test differentiated between players with and without groin pain (groin pain vs tenderness group: P = 0.011; groin pain vs no groin pain group P < 0.001). Four HAGOS subscales (pain, symptoms, sport/recreation, and quality of life) differentiated between players with and without groin pain ( P < 0.05).

CONCLUSIONS

One in five academy soccer players experiences groin pain with adductor-related most common during a midseason screening. Both Copenhagen 5-second squeeze test and HAGOS subscales can differentiate between players with and without groin pain.

Effects of a Groin Pain Prevention Program in Male High School Soccer Players: A Cluster-Randomized Controlled Trial

Background

Groin pain is frequently reported by soccer players. A prevention program incorporating the Copenhagen adduction exercise (CAE) has been shown effective in decreasing adductor muscle injury in semi-professional soccer players. However, the effect of such programs on groin pain in high school soccer players is unknown. No reports have examined the effects of combining the CAE with other targeted exercises such as the Nordic hamstrings exercise (NHE).

Purpose

To evaluate the preventative effects of exercise on groin pain in high school soccer players in three groups comprising NHE alone, combined NHE and CAE, and a control group.

Design

Randomized Controlled Clinical Trial.

Methods

A cluster randomized controlled trial spanning 16 weeks was conducted on 202 high school soccer players from seven high schools in a Japanese under 18 Soccer League. Players were allocated to either group A (three schools, 66 players) receiving the CAE alone, or group B (two schools, 73 players) receiving the CAE and NHE, or control group C (two schools, 63 players) who performed their usual training. This study compared the number of injuries, injury rate, and severity of the injury of groin pain in these three groups.

Results

The number of players injured was less in group B (4 players) compared to C (18 players), and time-lost to soccer was less in groups A (6 players) and B (3 players) compared to group C (16 players). Injury rates were significantly lower in groups A and B, with the relative risk of injury compared to group C of 0.42 (95% CI 0.19% to 0.90%) in group A and 0.19 (95% CI 0.07 to 0.54) in group B.

Conclusion

A 16-week program incorporating the CAE in training sessions in high school soccer players reduced the incidence of groin pain and which may be related to injury severity according to time -lost to soccer, however the combination of both the CAE and NHE may be more effective than the CAE alone.

Level of Evidence

2b.

Hip Adduction and Abduction Strength Profiles Among Bantam, High School, Juniors, and Collegiate American Ice Hockey Players

Background

Adductor strains are the most common non-contact musculoskeletal injury sustained in ice hockey. Systematic reviews have determined higher level of play and lower hip adduction to abduction strength ratios to be associated with an increased risk of adductor strain across multiple sports. Limited research exists regarding hip adduction and abduction strength profiles across various levels of ice hockey players.

Purpose

To compare isometric hip adduction and abduction strength profiles among bantam, high school, tier one juniors, and NCAA Division I collegiate ice hockey players. A secondary purpose was to identify whether differences in strength profiles between dominant and non-dominant limbs exist.

Study Design

Cross-sectional cohort study.

Methods

A questionnaire of demographic data, hockey, and injury specific information was completed by all subjects. The mean of three reps of maximal hip isometric adduction and abduction strengths were quantified using a handheld dynamometer with external belt-fixation. Ratios of hip adduction-to-abduction strength were calculated and normalized for body weight.

Results

A total of 87 uninjured skaters were included in this study with a mean age of 17 years. Mean hip adductor-to-abductor ratios for Bantam hockey players were 121% followed by collegiate (115%), Juniors (111%), and high school (109%) hockey players. No statistically significant differences were found between peak hip adduction and abduction isometric strength and playing level. In addition, there was no difference between unilateral hip strength ratios and shooting hand or leg dominance. While 34.5% of subjects reported a history of adductor injury, no significant differences existed regarding strength ratios during bilateral comparison or when compared to their team norms. Three subjects were found to have unilateral ratios of less than 80%, while two subjects demonstrated bilateral ratios of less than 80%.

Conclusions

Symmetry is illustrated between dominant and non-dominant legs in ice hockey players with and without a history of adductor injury. Results align well with previously established cross-sectional data from Australian football, with ratios of 103% in high school players, 107% in semi-professional players, and 113% in collegiate players.

Level of Evidence

Level 3.

Incidence, Prevalence, and Severity of and Risk Factors for Hip and Groin Problems in Swedish Male Ice Hockey Players: A 1-Season Prospective Cohort Study

CONTEXT

The epidemiologic focus on time loss may underestimate the true magnitude of hip and groin problems in male ice hockey players.

OBJECTIVE

To describe the prevalence, incidence, and severity of hip and groin problems (time loss and non-time loss) in Swedish ice hockey players over the course of a season and explore potential preseason risk factors for these conditions.

DESIGN

Prospective 1-season cohort study.

SETTING

Professional and semiprofessional Swedish ice hockey players.

PATIENTS OR OTHER PARTICIPANTS

A total of 12 professional and semiprofessional male ice hockey teams were invited to participate. Of those, 9 teams agreed, and 163 players were included in the analyses.

MAIN OUTCOME MEASURE(S)

Hip and groin problems in the previous season (time loss, non-time loss), isometric adduction and abduction strength, and 5-second squeeze test results were recorded before the season and served as independent variables in the risk factor analysis. Main outcome measures were cumulative incidence of hip and groin problems, average prevalence, and odds ratios (ORs) for groin problems in season.

RESULTS

Cumulative incidence was 45.4% (95% CI = 37.6%, 53.4%) for all problems and 19% (95% CI = 13.3%, 25.9%) for substantial problems. Average prevalence was 14.1% (95% CI = 10.8%, 17.5%) for all and 5.7% (95% CI = 4.3%, 7.2%) for substantial problems. Among reported problems, 69.2% had a gradual onset, and only 17% led to time loss. Players with non-time-loss problems in the previous season had higher odds for new problems (all: OR = 3.3 [95% CI = 1.7, 6.3]; substantial: OR = 3.6 [95% CI = 1.8, 8.4]). Preseason strength was not significantly associated with the odds for subsequent problems.

CONCLUSION

Hip and groin problems are common in ice hockey players and may lead to substantial impairments in performance. Only 1 in 5 problems led to time loss, and 7 in 10 had a gradual onset. Non-time-loss problems in the previous season were a significant risk factor for new problems, whereas decreased preseason hip-adduction and -abduction strength was not.

Hip and groin function and strength in male ice hockey players with and without hip and groin problems in the previous season- a prospective cohort study

OBJECTIVE

To describe and compare hip and groin strength and function of male ice hockey players over one season in players with and without hip and groin problems in the previous season.

DESIGN

Prospective cohort study.

SETTING

Swedish male ice hockey.

PARTICIPANTS

We followed 193 players from 10 teams during the 2017/2018 season.

MAIN OUTCOME MEASURES

Hip adduction and abduction strength, 5 s squeeze test (5SST), and self-reported hip and groin function (Hip and Groin Outcome Score). Changes over the season and differences between players with and without problems in the previous season were analyzed by linear mixed models.

RESULTS

Adduction strength decreased slightly from pre-to mid-season and abduction strength increased slightly over the full season. However, self-reported function or pain did not change. Players with hip and groin problems in the previous season had significantly worse self-reported function, and more groin pain during the 5SST compared to players without. Strength measurments did not differ between groups.

CONCLUSIONS

Hip muscle strength, groin pain, and self-reported function appear to remain stable throughout the season in male ice hockey players. Remaining impairments in players with problems in the previous season suggest that function does not recover by ice hockey participation alone.

Maximal hip muscle strength and rate of torque development 6-30 months after hip arthroscopy for femoroacetabular impingement syndrome: A cross-sectional study

OBJECTIVES

Reduced sports function is often observed after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Impaired muscle strength could be reasons for this. We aimed to investigate hip muscle strength after hip arthroscopy for FAIS and its association with sports function and participation.

DESIGN

Cross-sectional study.

METHODS

We included 45 patients (34 males; mean age: 30.6 ± 5.9 years) after unilateral hip arthroscopy for FAIS (mean follow-up [range]: 19.3 [9.8-28.4] months). Maximal isometric hip muscle strength (Nm/kg) including early- (0-100 ms) and late-phase (0-200 ms) rate of torque development (Nm∗kg^-1∗s^-1) for adduction, abduction, flexion, and extension was measured with an externally fixated handheld dynamometer and compared between operated and non-operated hip. Associations between muscle strength and self-reported sports function and return to sport were investigated.

RESULTS

For maximal hip muscle strength, no between-hip differences were observed for adduction, abduction, flexion, and extension (p ≥ 0.102). For rate of torque development, significantly lower values were observed for the operated hip in flexion at both 0-100 ms (mean difference: 1.58 Nm∗kg^-1∗s^-1, 95% CI [0.39; 2.77], p = 0.01) and 0-200 ms (mean difference: 0.72 Nm∗kg^-1∗s^-1, 95% CI [0.09; 1.35], p = 0.027). Higher maximal hip extension strength was significantly associated with greater ability to participate fully in preinjury sport at preinjury level (odds ratio: 17.71 95% CI [1.77; 177.60]).

CONCLUSIONS

After hip arthroscopy for FAIS subjects show limited impairments in maximal and explosive hip muscle strength between operated and non-operated hip. Higher muscle strength was positively associated with higher sports function and ability to participate in sport.

Screening to Detect Hip and Groin Problems in Elite Adolescent Football (Soccer) Players - Friend or Foe?

Injury prevention strategies in team settings should not overlook early detection and secondary prevention. Monitoring systems may be an effective approach to detect common and troublesome injuries, such as hip and groin pain in football (soccer) players. The purpose of this International Perspective is to share our experiences with monitoring hip and groin pain in youth academy football and discuss challenges that surfaced. We consider why players may not accurately report pain, their perceptions of groin pain, and whether all groin pain is clinically meaningful.

LEVEL OF EVIDENCE

5.

Hip and Groin Injury Prevention in Elite Athletes and Team Sport - Current Challenges and Opportunities

Hip and groin injury (HAGI) has been reported as a source of significant time loss in elite sport. Field and court-based sports such as basketball, football, hockey, soccer, among others, require explosive multiplanar movement in single stance and high-speed change of direction. Often situations arise where sub-optimal pre-season training has occurred or congested in-season competition minimizes physiologic recovery periods between bouts of physical activity, both of which could magnify concomitant existing risk factors and increase injury risk. Identification and management of HAGI can be challenging as numerous structures within the region can be drivers of pain and injury, especially when considering the likelihood of concurrent pathology and injury reoccurrence. Focused prevention strategies have been suggested, but their practical clinical implementation has not been heavily investigated across the sporting spectrum. The purpose of this commentary is to review the historical and current state of HAGI, while focusing on applying evidence and clinical experience towards the development of future risk reduction strategies. Level of evidence: 5.

HIP AND GROIN PROBLEMS IN THE PREVIOUS SEASON ARE ASSOCIATED WITH IMPAIRED FUNCTION IN THE BEGINNING OF THE NEW SEASON AMONG PROFESSIONAL FEMALE ICE HOCKEY PLAYERS - A CROSS SECTIONAL STUDY

Background

Hip and groin problems are common in ice hockey but studies on professional female players are sparse. The available literature describes hip and groin problems by reporting incidence of time-loss injuries and may thereby underestimate the scope of these problems, which are often due to overuse and may not lead to absence from ice hockey participation.

Purpose

The purpose of this study was to describe the seasonal prevalence and severity of hip and groin problems in professional female ice hockey players. A further aim was to examine the relation between previous problems and self-reported function in the beginning of the new season.

Study design

Cross-sectional study.

Methods

Female ice hockey players from the highest league in Sweden [n=69 (19 goalkeepers, 18 defenders, 30 forwards)], responded to an online survey, retrospectively assessing the prevalence of hip and groin problems (time loss and non-time loss) and their duration during the previous season. Furthermore, players reported current self-reported function on the Copenhagen Hip and Groin Outcome Score (HAGOS).

Results

Two thirds of the players experienced hip and groin problems during the previous season [62.3% (N=43)]. A quarter of the players experienced a hip and groin problem leading to time loss [26.1% (N=18)]. The majority of problems were of short (1-2 weeks) or medium (3-5 weeks) duration [29% (N=20) of players, respectively], while longstanding problems ( ≥ 6 weeks) were rare [4,4% (N=3)]. Players that retrospectively reported hip and groin problems during the previous season reported statistically significant impairments on all HAGOS subscales in the beginning of the new season (p ≤ 0.011).

Conclusion

Hip and groin problems are prevalent in professional female ice hockey players, experienced by 62% during the previous season with resulting time-loss in 26.1%. Reported problems were rarely of longstanding nature, but players who reported problems in the previous season had significantly impaired hip and groin function in the beginning of the new season. Even though results of this study are based on retrospective player reports this may be a first step toward a greater understanding of the true burden of hip and groin players in professional female ice hockey players.

Level of evidence

3b.

High prevalence of hip and groin problems in professional ice hockey players, regardless of playing position

PURPOSE

The prevalence of hip and groin problems in professional male ice hockey is unknown and suspected to differ between playing positions. The purpose of this study was to explore potential differences in the seasonal prevalence of hip and groin problems between playing positions in male elite ice hockey players and to explore the relationship between symptom duration and hip and groin function at the beginning of the new season.

METHODS

Male ice hockey players [n = 329 (92 goalkeepers, 93 defensemen, 144 forwards), Mean age (SD): 24 (5)] from the professional leagues in Sweden responded to an online survey. The survey assessed presence of hip and groin problems (time loss and non-time loss) and symptom duration (categorized into 0, 1-6, or > 6 weeks) in the previous season, and current self-reported hip and groin function (Copenhagen Hip and Groin Outcome Score).

RESULTS

During the previous season, 175 players (53.2%) had experienced hip and groin problems. Non time loss problems were experienced by 158 (48%) and time loss problems were experienced by 97 (29.5%) players. No significant differences between playing positions were found. Self-reported function differed significantly between players with different symptom duration and more disability was reported among players with longer symptom duration (p ≤ 0.002).

CONCLUSION

Regardless of playing position, hip and groin problems were prevalent in male ice hockey players. Players with hip and groin problems during the previous season had significantly worse hip and groin function in the beginning of the new season, and longer symptom duration was associated with more disability.

LEVEL OF EVIDENCE

III.

Elite Ice Hockey Goalkeepers Have a High Prevalence of Hip and Groin Problems Associated With Decreased Sporting Function: A Single-Season Prospective Cohort Study

BACKGROUND

The modern style of goalkeeping in ice hockey is thought to predispose athletes to hip and groin problems. However, little is known about the magnitude of these problems in elite goalkeepers.

PURPOSE

To describe the incidence, prevalence, and severity of hip and groin problems in elite ice hockey goalkeepers over the course of a single season.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

We invited all elite Swedish ice hockey goalkeepers (n = 128) to participate in this prospective cohort study. Every second week, players reported hip and groin problems experienced within the past 14 days on the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O), classifying problems into "all" and "substantial" hip and groin problems. Three times during the season (pre-, mid-, and end-season), players reported hip and groin function on the Hip and Groin Outcome Score (HAGOS) as well as on the OSTRC-O.

RESULTS

A total of 101 goalkeepers participated in the study (83.3% male [seniors, 44.1%; juniors, 39.2%], 16.7% female). The cumulative incidences of all hip and groin problems and substantial hip and groin problems were 69% (95% CI, 59%-79%) and 36% (95% CI, 26%-46%), respectively. The average biweekly prevalence for all hip and groin problems and substantial hip and groin problems was 28.1% (95% CI, 25.0%-31.3%) and 10% (95% CI, 8.7%-11.4%), respectively. Among all the reported hip and groin problems, 16.9% (n = 70) were acute, 83.1% (n = 343) were because of overuse, and 15.5% (n = 64) led to time loss. HAGOS did not differ in the pre-, mid-, or end-season. Players reporting hip and groin problems on the OSTRC-O had significantly worse HAGOS scores than players without problems (P < .01).

CONCLUSION

Hip and groin problems are highly prevalent in elite ice hockey goalkeepers. During a competitive season, 69% of players experienced hip and groin problems and 36% of players suffered from substantial problems. The vast majority of problems were because of overuse, not leading to time loss but related to reduced self-reported hip and groin function.